Goals: The faculty will strive to:

1. Provide fourth year medical students with the opportunity to function as an "acting intern" in the Intensive Care Unit supervised by upper level residents, Hospitalist Fellows and Attending Faculty.
2. Teach fourth year students an evidence base approach to the care of critically ill patients in the ICU.
3. Provide fourth year students with an in depth approach to the variety of medical illnesses encountered in Internal Medicine.
4. Allow the student to preform diagnostic procedures on their patients when indicated.

Objectives: Upon completion of the rotation, the student should be able to:

1. Gather pertinent information, formulate a comprehensive plan of care and request appropriate tests for managing patients with critical illnesses.
2. List the differential diagnoses and understand the management of common illnesses encountered in the ICU setting: Respirator Failure, Sepsis, Diabetic Ketoacidosis, Multi-organ System Failure, Shock, and GI Bleeds.
3. Manage fluid and electrolyte disorder, enteral and parenteral nutrition, acid-base disorders and adjustment of ventilator settings.
4. Perform the following procedures: central line placement, arterial catheterizations, lumbar punctures, thoracentesis, paracentesis, endotracheal intubations and PA catheterizations of critically ill patients under direct supervision.
5. Present a comprehensive plan of care of his\her patients daily to the ICU.

Learning activities:

1. The student will be assigned his/her patients from admission and continue to follow these patients until their transfer from the ICU. The student will work under the direct supervision of the upper level resident Hospitalist Fellow of faculty.
2. The student will take the initial history, examine the patient and present a comprehensive plan of care to the supervising resident or faculty. He/she shall write the HP, all the orders, maintain a daily problem list and write daily progress notes.
3. The student shall participate in codes and other resuscitative efforts in the ICU.
4. The student will participate daily in Morning Report Noon conferences and ICU Rounds.
5. The student shall take call with the upper level resident one night per week for the duration of the rotation.

Learning Resources:

1. Harrison's Textbook of Internal Medicine, Pulmonary and Critical Care Sections
2. Texas A&M College of Medicine Library
3. Christus Spohn Hospital Memorial Library
4. PDA with stored text. Students may use their own or loan one for the duration of their rotation
5. Daily didactic lectures in ICU by Attending Faculty selected review articles

Evaluation:

1. The Standard Clinical Evaluation form will be used
2. The student will also have the opportunity to evaluate the rotation, faculty and residents